1. Cervical Spine

2. TECHNICAL ASPECTS
In all cervical spine views, a moving or a stationary grid must be used
(lateral is an exception, where an air-gap technique is generally
used).
Minimum kVp range is ( ) KVp.
Optimal exposure is required to show soft tissue as well as proper bone
density of the entire cervical spine. A small focus improves image detail.
Collimation must strictly be applied in all projections.
Exposure on fully suspended expiration.

3. AP Cervical spine (C1 – C2) Open Mouth B
To show pathology involving C1 and C2 (dens).
Patient supine (AP) or erect, the head adjusted so that with the mouth is open, a line from lower margin of upper incisors to the mastoid tips is perpendicular to the film. Mouth should be wide open during exposure.
Film: HD 18x24 cm lengthwise.
CP: Center of open mouth.
CR: 90 to film center.

4. Dens
Body
( C2 )
Lateral
Mass
(C1)

5. AP Axial Cervical (C3 – C7) B
To show pathology of the mid and lower cervical spine (C3 – C7).
Patient supine (AP) or erect, a line from the occlusal plane to the mastoid tips must be 90 to the couch.
Film: 24x30 cm. Lengthwise.
CP: Level of lower margin of the thyroid cartilage
to pass through c4.
CR: 15- 20 cephalad.

6. Anterior and Posterior oblique Cervical spine B
Pathology involving cervical spine. AOs are preferred because of reduced thyroid doses.
Patient erect, arms at sides, body and head rotated 45, chin extended.
Film: 18x24 cm.
CP: Level of upper the margin of thyroid cartilage to
pass through C4.
CR: AO: 15- 20 caudad.
PO: 15- 20 cephalad

7. C1 C2
pedicles
Intervertebral
foramen

8. Lateral Cervical spine B
For pathology involving cervical spine .
Patient in erect lateral (stand or sit), shoulder depressed (with equal weights), forward, and against vertical film, cassette top margin 1 inch above EAM.
Film: 24x30 cm lengthwise .
CP: Level of upper margin of thyroid cartilage to pass
through C4 – C5.
CR: 90 to film center, FFD 180 cm.

9. C1
spinous
process C2 C7

10. Lateral Cervical spine (trauma case) B
To show pathology in cervical spine (#s and subluxations).
Patient in supine on a stretcher or on couch.
Film: HD 24x30 cm lengthwise.
CP: level of upper margin of thyroid
cartilage, to pass through C4.
CR: Horizontally 90 to film center.
FFD : 180 cm

11. Cervicothoracic Lat Cerv Spine (Swimmer’s lat), B (Twining method)
For cervical and thoracic vertebra demonstrated.
Patient erect (or sitting), patient’s arm and shoulder close to film raised up, elbow flexed, forearm resting on the head, other arm and shoulder by the side and slightly anterior,
Film: 24x30 lengthwise .
CP: 1 inch above the level of jugular notch (opposite T1)
CR: Horizontally 90 to film center.

12. Lateral Cervical (Hyperflexion and hyperextension) S
Functional study the dynamics (motion/ lack of motion) of the cervical vertebrae.
Patient sits or stands in the erect lateral, shoulders depressed (weights may be used), neck hyper-flexed (chin touches the chest) or hyperextended (head leaned back), as required.
Film: 24x30 cm.
CP: Level of upper margin of thyroid cartilage to (C4).
CR: Horizontally 90 to film (FFD: 180 cm).

13. PA Cervical spine (C1 – C2, dens) Judd Method S
To show pathology involving the odontoid process (dens) and C1 and C2 structures. Done when the dens is not clearly shown by the (open -mouth technique) , and produces less dose to the thyroid.
Patient prone, chin resting on tabletop and extended so that MML is 90 to table.
Film: 18x24 cm.
CP: Through mid-occipital bone, 1 inch inferopo-
sterior to the mastoid tips and angles of the
mandible.
CR: Parallel to MML.90 to film

14. Mandible
dens
Foramen
magnum
Occipital
bone

15. AP Cervical Wagging-Jaw method S
To show pathology involving entire C1 with mandible blurred-out (similar to tomography).
Patient supine, head on couch and adjusted so that a line from lower margin of upper incisors to base of the skull is 90 to the couch, the mandible should be continually moving during exposure without moving the head.
Film: HD 18x24 cm.
CP: Upper margin of the thyroid cartilage (C4).
CR: 90 to center of film.

16. TABLE 2 (Exposure Factors)
PROJECTION
kVp
mAs
AP Cervical (C1 – C2, Dens), Judd Method 75 15
AP Cervical (C1 – C2), ‘Open-Mouth Technique’
AP Cervical (C1 Ring), ‘Wagging Jaw Technique’
AP Axial (C3 – C7) 10
APO Cervical
Lateral Cervical (trauma case) 28
Lateral Cervical (hyperflexion/ hyperextension)
Cervicothoracic Lateral (C4 – T3), ‘Swimmer’s View’ 80
120

17. TABLE 2 (Exposure Factors)
PROJECTION
kVp
mAs
Lateral Cervical 75 28
AP Axial Cervical (Vertebral Arch – Pillars) 12
AP/ AP Axial clavicle 70 8
ACJs (Bilateral) 65 20
AP Scapula 7
Lateral Scapula 13